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THE 



CLIMATE AND DISEASES 



OF THE 



GULF COAST OF THE FLORIDA PENINSULA, 

WITH REMARKS ON THE FORMER 

IN RELATION TO PULMONARY TUBERCULOSIS. 

/ 
By J. P. WALL, M. D. ; 

TAMPA, FLA. 










CHARLESTON, S. C. 
PRINTED BY H. P. COOKE & CO. 

52 BEOAD STREET. 

1874. 



. 



Y 






<^o 



[From the Charleston Medical Journal and Review, July, 1874.] 



ART. II.— The Climate and Diseases of the Gulf Coast of the 
Florida Peninsula, with remarks on the former in relation to 
Pulmonary Tuberculosis. By J.* P. Wall, M. D , Tampa, Fla. 

By the " gulf coast," it is meant to include a distance of about 50 
miles or more into the interior, where is found the natural water shed, 
dividing the peninsula in its length into two nearly equal portions, 
till the immediate vicinity/ the Everglades, is reached, in the extreme 
southern portion. The gulf coast extends from Cedar Keys, 29° 07', 
to Cape Sable, the extreme point on the main land, in latitude 25° N., 
a distance of about 240 miles. North of the 28° of latitude, the 
mean altitude immediately along the gulf coast is about 15 feet, with 
some exceptional points of greater elevation. In the interior the 
mean altitude is about 40 feet to below Fort Meade, and then 
gradually declines to about 20 feet, with a still further decline in the 
vicinity of the Everglades. North of Tampa Bay, on the coast, and 
Fort Meade, in the interior, the country is more or less undulating, 
with some considerable hills, and is peculiar in many places for its 
subterranean drainage, most of the rain water escaping through sub- 
terranean passages. South of Tampa Bay and Fort Meade the coun- 
try is generally level, and, the rain water being got rid of only by sur- 
face drainage, is subject to more or less inundation by the heavy rain- 
fall of the summer. Many small rivers empty into the various bays 
and harbors, with which the coast is frequently indented all along, 
some of which rise as springs in a full volume^from the bowels of the 
earth. These latter, however, are only found in those sections 
abounding with subterranean vents for the rainfall, and consequently 
none are found south of the 28° of latitude. 

The character of the country is that of piney woods, interspersed 
with hammocks, swamps, lakes, ponds, and prairies of variable extent, 
respectively, from one to thousands of acres. The soil is moatly a 
silicious sand, of a porus nature, on a substratum of clay, more rarely, 
marl or rock. More or less vegetable debris in proportion to the 
quantity and luxuriance of the forest growth, is found intimately 
mixed with the surface soil. Lime rock is found generally, and in 
many places crops out of the surface of the ground. In many locali- 
ties the water is hard. Springs, impregnated with sulphur, and more 
or less slightly, with other minerals, are quite common. 

The natural growth is pretty much the same as that of Georgia 



2 Wall 071 Climate and. Diseases of Florida. 

and the other Southern States, with the exception of the wild orange, 
and, in the extreme Southern part, the palm and cocoa nut trees. 

Meteorology. — Tampa, being nearly centrally situated on the gulf 
coast, and some 30 miles interiorly from the gulf, at the head of 
Hillsborough Bay, is selected as a fair medium locality for the fol- 
lowing meteorological observations. These are taken from the statis- 
tical report of the Surgeon General's office, published in 1856 : The 
mean temperature for the faif seasons, and for the whole year, for 25 
years, is, spring, 72°08 ; summer, 80°20 ; autumn, 71°04: winter, 
62°35 ; whole year, 72°48. The mean rain-fall for the Jair seasons 
and for the whole year, for 16 years, is, spring, 8.56 inches ; summer, 
28.24 inches; autumn, 10.63 inches; winter, 8.04 inches f whole 
year, 55.47 inches. The following summary of the weather is the 
mean for 9 years : (the capitals indicate the direction of the wind, 
and the figures the number of days from that direction.) N., 27 ; 
N. E., 73 ; E., 60 ; S. E., 44 ; S., 40 ; S. W., 43 ; W., 43 ; N. W., 
29; fair, 234; Cloudy, 143; rain, 98. 

As regards the hygrometric condition of the atmosphere, it is to be 
regreted that no observations have been made ; the same is also true 
of the presence of ozone. The climate, however, may safely be class- 
ed as a moderately dry one, at least ; and this conclusion is arrived at 
from the 'coolness of the nights, causing universally and invariably, 
except in very cloudy weather, no inconsiderable fall of dew, while 
the thermometer usually falls from 10° to 20° below the maximum 
range of the day. These facts indicate the great rapidity of radiation 
from the earth ; it being well understood that saturation of the atmos- 
phere, with aqueous vapor, is inimical to the radiation of heat. Prof. 
John Tyndall says : " Wherever the air is dry, we are liable to daily 
extremes of temperature. By day, in such places, the sun's heat 
reaches the earth unimpeded, and renders the maximum highj; by 
night, on the other hand, the earth's heat escapes unhindered into 
space, and renders the minimum low. Hence the difference between 
the maximum and minimum is greatest where the air is driest."* 

The atmosphere is to a remarkable degree antiseptic, except during 
the heavy rain-fall of summer, This is, no doubt, dependent on the 
presence and oxydizing properties of ozone, together with the natural 
dryness of the climate. The precipitation of moisture in the atmos- 
phere, as fog, is extremely rare, only occurring occasionally, by no 
means regularly, in the fall and spring. 

The highest meridian range of the thermometer rarely reaches 96 6 , 
and never exceeds it, even in the very hottest days of summer, while 
more or less breeze, almost universally, day or night, is present. The 
nights, even during the summer, are remarkably cool, and few trans- 
pire in which some light covering in bed is not required, especially 
from midnight till after sunrise. Continuous exposure to the night 
air seldom fails to produce unpleasant, chilly sensations, when only 
protected by the customary daily habiliments. 

* Fragments of Science. Article— Radiation. 



Wall on Climate and Diseases of Florida. 3 

Diseases.—- -The catalogue of endemic diseases of the gulf coast only 
comprise those of malarial origin, viz, intermittent and remittent 
fevers. Of these the types are, as a rule, mild, the pernicious varie- 
ties being but exceptionally encountered. And for the last few years 
the malarial fevers have been notably less common than before and a 
few years subsequent to the late war. This may be accounted for, to 
a great extent, by the abandonment of large plantations, where annu- 
ally more or less new lands were prepared for cultivation by paring 
the lands of the smaller growth, and killing the larger timber by gird- 
ling it with the chops of an axe, from which naturally resulted no 
inconsiderable amount of lignious decomposition, besides exposing the 
new soil to the direct rays of the sun. In my experience hsematuria 
has but rarely manifested itself as a complication, while some physi- 
cians say they have never encountered it. At any rate, I have never 
noticed it as a dangerous complication with the pathological phenome- 
na described by the physicians of the other Southern States. It Was 
simply a hsematuria, coming on in the hot stage, and disappearing in 
the apyrexia ; the hemorrhage never assuming alarming proportions. 

The treatment of the malarial fevers is generally that ordinarily 
pursued ; the exhibition of an ordinary vegeto-mercurial purgative, 
followed by quinine at short intervals during the intermission or re- 
mission of the fever. Usually from twelve to twenty grains of qui- 
nine, in divided doses, given in the course of eight or ten hours, suf- 
fice to check the paroxysms of intermittent, and stop, or greatly miti- 
gate, remittent fever. The hsematurial variety is generally treated in 
the same manner, with the addition of a sinapism to the loins, and 
sometimes the use of the warm bath. In the pernicious varieties, 
commonly spoken of in Florida as congestive chills, the salvation of 
the patient depends on early and rapid cinchonism. Once the chill 
and congestion are thoroughly established, with extremities cold up 
nearly to the body, the stomach becomes intolerant of stimulants and 
medicines, or its functions are in abeyance to such a degree that no 
absorption takes place, so that their administration proves futile. 
Under such circumstances, in a few instances I have admistered twen- 
ty or thirty grains of quinine, hypodermically, being compelled to use 
some vegetable acid for its solution, through several different punctures, 
with curative results. For hypodermic use the muriate of quinine, being 
more soluble in water, is to be preferred to the sulphate. It is grati- 
fying to state, however, that in a practice embracing a very large area 
of territory, I have not met with nor heard of a case for several years. 

The continued fevers, typhoid and typho-malarial, or any other 
variety of continued fever, have never occurred within my experience 
of fifteen years ; nor have I heard of any within the experience of 
others. From these forms of fever this portion of the State is totally 
exempt ; nor do I hear of them prevailing in other sections of the 
State with denser populations. 

Yellow fever and dengue are occasional visitants of the seaport 
towns, and in a residence of three years in Tampa, I have seen an 



*-# - 



, 






• - 

- 



4 Wall on Climate and Diseases of Florida. 

epidemic of each — yellow fever in 1871, and dengue in 1873. As 
usual^ those attacked by yellow fever were recent residents, who 
had never been exposed to its infection before. The geographical 
position and commercial relations of the gulf ports will, no doubt, 
always render them peculiarly obnoxious to the occasional epidemic 
prevalence of yellow fever, and this latter will likely increase pari 
passu, with their growth and commercial importance. In the epidem- 
ic of 1871, it prevailed also at Cedar Keys, and from thence was car- 
ried to Grainsville, a town a hundred miles from the Keys, in the 
interior. In my observations of the epidemic in Tampa, it was 
noted that a fever with a temperature of 106° F. and upwards inva- 
riably proved fatal. At that .time I failed to appreciate the patho- 
gnomonic significance of a gradually lowering pulse rate, contrasted 
with a high temperature, so clearly pointed out since by Dr. Faget. 
of New Orleans. 

Idiophatic diseases of the liver — except the occasional occurrence of 
jaundice — have never come under my observation, and I am inclined 
to the opinion that they are very uncommon. Those histological 
metamorphoses as phathological concomitants of the malarial fevers, 
resulting in pigmentation, or bronzing of the organ, are probably com- 
mon, but how much of structural or functional disease, if any, is de- 
pendent on them, is as .yet an undetermined question. 

Enlargement of the spleen is incidental to the malarial fevers, and 
the malarial caohexia ; and in the latter the enlargement may be 
more or less chronic in its nature. 

Acute inflammatory affections of the respiratory organs — except an 
occasional catarrh with some bronchitis — are extremely infrequent as 
a rule j though here, as elsewhere, an epidemic influenza sometimes 
prevails, during which serious pulmonary complications in some cases 
are developed, taking their departure apparently from the epidemic 
disease. But idiopathic pneumonia and pleurisy occur very rarely, 
and are never so common as to be considered as even approximating 
either an endemic or epidemic character. 

Diarrhoea and dysentery only occur as sporadic diseases, and never 
in an epidemic or malignant form. These diseases are generally mild, 
and readily yield to treatment. 

No case of acute rheumatism has ever come under my observation, 
except when the patient was also suffering with a gonorrhoea! dis- 
charge, more or less acute. I have noted three such cases ; one in a 
negro man aged 22, where the knee joint was acutely inflamed ; one 
in a white man aged 38, with the shoulder joint the seat of the rheu- 
matism; and a negro woman aged 22, when the wrist was the joint 
attacked. In all these cases my services were first sought in conse- 
quence of the rheumatic disease, and the presence of gonorrhoea ad- 
mitted in the course of the clinical examination. In the case of the 
woman, her husband had but recently been under tieatment for gon- 
orrhoea, and she complained of having the " whites. " 



Wall on Climate and Diseases of Florida. 5 

Cerebrospinal meningitis, either as sporadic or epidemic has never 
occurred in this section of the State south of Ocala, where it was said 
to have prevailed in the winter of 1863-1864. Whether the diagno- 
sis was merely made from the clinical history of the cases, or confirm- 
ed by post-mortem examinations. I do not positively know, but am 
inclined to the opinion that confirmatory evidence in anatomical lesions 
was not sought for. During the same season a disease presenting 
manv of the symptoms of cerebro-spinal meningitis, prevailed exten- 
sively among the negro laborers employed on the fortifications at 
Baldwin, and on the St. Mary's river, but unfortunately, on account 
of the exigencies of the military situation then pending, the positive 
character of the disease was not determined by autopsies. If this was 
cerebro-spinal meningitis it is the only time that the disease has been 
known to prevail in the State. At the time many of the medical 
officers of the Confederate service were inclined to the opinion that 
this disease was pernicious malarial fever of cerebral congestive type. 
In the few cases which I saw at the time in Lake City, the subjects 
being negroes, if there was any petechial eruption it escaped observa- 
tion. 

Trismus Nascentium is not more common in this section than is 
general throughout the Southern States ; and while more common 
among the negroes, it is by no means exclusively confined to that 
class of our population. In my experience, however, trismus has not 
been a very frequent disease. 

Traumatic tetanus very rarely occurs after injuries and wounds or 
surgical operations. In fact this disease is so extremely infrequent as 
never to occasion the surgeon any apprehension of its being developed 
as a complication. Among the wounded at the battle of Olustee, in 
February, 1864, tetanus was much more common than had come under 
my observation in a previous considerable service in the general mili- 
tary hospitals of Richmond, Va. The night, following the battle in 
the afternoon, was very cold for Florida, and the wounded were much 
exposed, both in their transportation to Lake City that night and 
after reaching there, in consequence of inadequate hospital accommo- 
dations. The disease was on that occasion almost exclusively mani- 
fested in connection with wounds of the foot and leg. 

The frequent occurrence of small nascent pterygium, especially 
among the males living on the coast, has appeared to me dependent 
on the reflection of the white sand so common when the coast is not 
margined by swamps. 

So far this section has escaped diphtheria in either a sporadic or 
epidemic form. There are not wanting those physicians, however, 
here as elsewhere, who, either from ignorance or an unprofessional, 
anxiety for reputation, call almost every affection of the throat diph- 
theria. 

Insolation or sunstroke never occurs in either town or country ; nor 
have I heard of its occurrence in Key West. The heat is never so 
excessive in this climate as either to cause disease or exercise an un- 



6 Wall on Climate and Diseases of Florida. 

favorable influence on the sick. On the other hand convalescence is 
always remarkably rapid as regards both diseases and surgical injuries. 

■Calculus affections of the urinary organs are never met with in ihis 
section, nor as I know of in any other part of the State. From the 
conditions favorable to the formation of verical calculi Florida ap- 
pears to be peculiarly exempt. p 

Of intestinal worms the most common varieties pre the ascaris lum- 
bricoides and ascaris vermicidaris. The tape-worm in any of its va- 
rieties is never met with ; nor do I believe that it is to be found in 
any section of the State. 

No instance of hydrophobia, in either animal or human, within the 
State has come within my knowledge. 

The mortality of this section is extremely low ; and that from ma- 
larial fevers, for the last few years, has been nil. And so far as statistics 
can be made available they show a less percentage of mortality for 
Florida than any other State in the Union. The entire abscence of 
many diseases more or less fatal in their character, and the greater 
mildness of those of malarial origin cannot fail to demonstrate the 
natural salubrity of the climate. Much of this exemption from the 
graver forms of disease depends doubtless upon its greater freedom 
from the extremes of temperature. 

On account of the sparseness of population, and the considerable 
distances between settlements, the eruptive • fevers have prevailed in 
this section of the State only daring times of war, when the infection 
was carried into communities by travelling, and returning soldiers. 
Thus did rubiola prevail quite extensively during the Seminole dis- 
turbances of 1856 and 1857 ; and the small pox more slightly in 
isolated communities in 1863 and 1864. Scarlatina broke out on the 
plantation, in Hernando County, of Hon. D. L. Yulee, in the spring 
of 1861 among the negro children and those (white) of the overseer's 
family. How the infection got there I was never able to discover ; 
though the family of the Hon. Senator having but recently arrived 
at the plantation from Washington, D. C., for a temporary sojourn, it 
is but reasonable to infer that this very tenacious and subtle conta- 
gious virus found its way there with them. The disease proved ex- 
ceedingly mild, and was followed by no unpleasant sequelae, In all 
there were thirty-five or forty cases and only one death, an infant 
(negro) aged nine months, in which bronchitis and lobular pneumo- 
nia were developed as intercurrent affections* Although throat affec- 
tions, with more or less glandular swellings, were sufficiently common 
to declare it of the anginose variety, yet upon the whole, the disease 
was so mild as to require confinement to bed in only a few instances. 
This is the only instance of the disease ever having been in this sec- 
tion ; and has been alluded to in confirmation of what would be 
naturally inferred in relation to the climate, the greater mildness of 
the eruptive fevers here than in higher and damper latitudes. 

Poisonous reptiles and insects are not more common and numerous 
in this section than they are generally throughout the Southern 



WALL on Climate and Diseases of Florida. 7 

States, and comprise only the same varieties. Mosquitoes, sand flies 
and other insects are generally less troublesome in this section than 
they are on the Atlantic and St. John's, or even in New Orleans. 
Here they are usually found in certain localities only, being very 
troublesome only in a few places, while in the greater portion of this 
section the use of bed nets is never required. 

Adaptability of the Climate to Consumptives. — As yet the influ- 
ence of the meteorological conditions of different climates on disease 
is not sufficiently understood as to enable us to determine, with any 
accuracy, what meteorological combinations may be either inimical to, 
or provocative of, disease. Up to within a recent period the tempera- 
ture of a climate was considered the principal factor in the causation 
of many diseases, and especially those of the respiratory organs. More 
recent observations and experience, however, have pretty clearly 
demonstrated that this belief or assumption can be predicated only to 
a very limited extent, indeed, of nearly all diseases, and particularly 
those of the respiratory organs. That ozone is only an allotropic 
state of oxygen is conceded by the latest chemical authorities ; and 
wether or not other allotropic conditions of the aerial elements, subtle 
and as yet undelectable, may exist, and, by their action on the human 
economy, cause disease, is a problem for future scientific elucidation. 
The assumption of such a theory — bringing an idiosyncratic suscepti- 
bility as an accessory factor — might go far towards the explanation 
of causation in many diseases in lieu of the germ or cryptogamic doc- 
trines. We are almost forced to such a conclusion to account for 
the different effects on human health of various but remote climates, 
similar in latitude, altitude and meteorological conditions. If this 
^L_pro^oxtion should be true of disease in general, it is but a reasonable 
supposition that it may be true also of pulmonary tuberculosis ; and 
until the ultimate laws of both biology and meteorological physics are 
more fully comprehended, it is impossible to judge a priori what cli- 
mates may prove beneficial, or otherwise, to consumptives. 

To the earnest and patient investigation of climatic influence on 
consumption, the conclusions arrived at by Dr. Manning Simons, of 
Charleston, S. C, (American Journal of Medical Sciences, January 
No,, 1872,)* may be taken as a fair expression of our present 
knowledge on the subject *. 

" 1. That phthisis occurs in every zone, and that its origin is not 
rendered impossible by any conditions of climate, of which we have 
any knowledge. 

" 2. That the disease, contrary to a very generally received opinion, ■ 
is not more frequent in cold regions, and that a great degree of cold 
does not seem to favor its production. 

" 3. That the same remark may be made in relation to heat. 

" 4. That of all the influences which are favorable to its develop- 
ment and progress, we must recognize moisture, especially combined 
with heat. 

" 5 That great variability in the qualities of heat, cold and 
moisture are, however, to be recognized as most injurious. 






.'■: 



; 



8 Wall on Climate and Diseases of Florida. 

• : 6. That the most inimical influence to the origin and development 
of the disease, is that exercised by the climatic conditions and habits 
belonging to extreme altitudes. 

"" 7. That consumption is, as a general rule, more frequently met 
with on sea-shores, and diminishes to a certain extent in proportion 
to the distances from these localities. 

" To nearly all of these statements, however, there are exceptions, 
In Madrid, according to Walshe, situated 2,000 feet above sea level, 
phthisis is common. He further says, that if we try to explain the 
rarity of phthisis in Algiers, and Egypt, and Syria, by the heat and 
dryness of the air combined, we are met by the difficulty that the 
East Indies enjoy a somewhat similar exemption, in spite of the mark- 
ed moisture of the heated atmosphere. In Iceland, where variability 
holds to a maximum degree, the disease is singularly rare.'* , 

The question, however, is not so much what climatio conditions are 
inimical to the development, as to the progress of pulmonary tubercu- 
losis. If, as Dr. Wilks (London Lancet, Feb., 1874) and others hold, 
rest is beneficial and exercise injurious in consumption, the adaptabili- 
ty of high altitudes to lungs already involved, because of the greater 
expansion required by the rarified air, appears questionable, and 
might be expected to prove measurably detrimental in proportion to 
the altitude. As regards sea coast, while no positive deductions can 
be drawn, there is some evidence going to show that western sea 
coasts are much more favorable for consumptives than eastern, as is 
illustrated by those of Sweeden and Scotland. 

As regards the beneficial efiects of warm climates in consumption, 
Dr. C. T. Williams (London Lancet, Aug., 1872) " furnishes, from 
the practice of Dr. C. J. B. Williams and himself, a statistical account 
of 251 cases of consumption, who passed periods varying from one to 
eleven winters in warm climates, out of the United Kingdom. 

" * * The average of winters passed abroad by each patient was 
2^ j and of 18 patients who took voyages, the average number of 
*V voyages per patient was 2 $. 

" The results of the climate on the general condition of these pa- 
tients were that 65 per cent, were more or less improved, 6 per cent, 
remained stationary, and 29 per cent became worse. The local effects 
on the lungs were, that in 43 } per cent, cure or decrease of the dis- 
ease took place, in 14 per cent, it remained stationary, and in 42 per 
cent, it increased either in the way of advance, or extension, or of 
both. 

" The influence oi various groups of climates is next considered, 
and from the results of a table, it is shown that the moist climates, 
temperate or warm, yielded a percentage of " improved, " varying 
from 50 to 55, of " stationary, " varying from 4$ to 141, and of 
u worse," from 32 to 45 ; also that the dry climates yielded per cent- 
age of*' improved," varying from 58 to 65, of u stationary/' from 20 
to 25, and of *' worse," varying from 10 to 21 j and that of the pa- 
tients who took sea voyages, 89 per cent, improved, 5 J per cent, 
remained stationary, and 5 1 per cent, became worse. ****** 






Wall on Climate and Diseases of Florida. 9 

" With reference to the question whether or no certain forms of 
consumption deiive special benefit from any particular climate, the 
author deduces from 55 cases of phthisis of inflammatory origin, who 
wintered in various warm or temperate localities, that a dry climate 
is more favorable than a moist one for the treatment of this form of 
the disease ; and as regards phthisis of catarrhal origin, the deduction 
from 41 patients is, that warmth and equability of climate are more 
important than dryness for patients of this description. 

" Forty of the climate cases died, and 202 were living at the last 
report. Among the former the average duration of life was eight 
years, and among the latter about nine years, which, when compared 
with the average of life among patients who did not go abroad, show- 
ed a slight extension of duration. The effect of cod liver oil in pro- 
longing life is demonstrated by the instances of 13 patients, who, 
though they had the full advantages of climate, either omitted oil or 
took it irregularly. Among these, who are all dead, the average du- 
ration was four years, eight months and a half." 

Dr. C J. B. Williams, in concluding a series of papers on pukno- 
nary consumption, (London Lancet, Nov., 1868,) says : 

" Of far more importance in the treatment of consumption is 
change of air and climate. It is of the greatest consequence to the 
phthisical invalid that he should breathe as pure an air as possible, 
and that the influence of this pure air on the blood and on the body 
should be increased by such gentle and varied exercise in it, as his 
strength and the condition of his organs will permit. This is the 
great object of our sending him to a warm climate in winter, and to a 
high and dry locality in the summer, that he may be as much as pos- 
sible in the open air, with its exhilerating and vivifying accessories 
of light, purity and freshness, without the chilling operation of cold 
and wet in the winter, and the enervating and exhausting influence 
of oppressive heat in the summer." 

As regards the influence of the climate of the Florida Peninsula on 
consumption, no reliable statistics have been collected, though the 
U. S. census for 1870 gives, for the whole State, only one death in 
1447. There is much reason for the opinion, however, that the 
interior and western slope of the Florida peninsula is climatically bet- 
ter adapted to those suffering with pulmonary tuberculosis than any 
other section of the Union. 

" The State is in the same latitude with the Des«rt of Sahara, 
Southern China and Northern Mexico ; v but its comparative degree of 
heat is not accurately indicated by its latitude, for it is isothemal with 
the Bermudas, Egypt, Northern Hindostan, Southern California and 
Louisiana." 

Happily, while engaged in writing this paper, Dr.,C. W. Horsey's 
(of Fernandina, Fla.,) article on the " climate of Florida," has appear- 
ed in the April number, 1874, of the American Journal of Medical 
Sciences ; and as an expression of the experience and the results of 
observation of a resident physician on the Atlantic coaat, deserves at- 



10 Wall on Climate and Diseases of Florida. 

tention, and the more especially as it is corroborative, to some extent, 
of the facts and opinions which I am endeavoring to set forth. In 
view also of its relieving myself of any appearance or accusation on 
the part of the Faculty of the Atlantic or St. John's country, of 
invidiousness or sectionalism, I am rejoiced at its opportune appear- 
ance. Premising that the doctor is mistaken as regards the persist- 
ent " humidity and frequent fogs " of this section — for I presume 
that his personal observations have not extended south of Cedar Keys, 
Micanopy and Ocala— I shall let him speak for the two sections ; 

" Fernandina and St. Augustine present the same features of cli- 
mate met with on the sea-board of semi-tropical countries elsewhere. 
The atmospheric conditions of both are identical, being invariably 
moist, especially at night and morning, and under the continued influ- 
ence of the sea breeze and wind currents from the ocean. During 
the winter months all points on the coast are exposed to the frequent- 
ly prevalent northerly storms, which last at times for days, and whose 
fierce and penetrating blasts are dimcult to be borne even by the 
hardy. On the St. John's, but little difference is observed in the 
atmosphere at the several places of resort on its banks. The country 
along the river, for the greater part of its course, is flat, with little 
elevation above the water level, and, as a rule, extensive swamps and 
hammocks fringe its borders. The river presents a succession of ex- 
pansions and contractions, conveying the idea of a continuous chain 
of lakes, some of which are indeed immense surfaces of water, and it 
is usually upon such expansions that the resorts are located. The 
evaporation from the water necessarily causes a very considerable 
amount of moisture in the air, which is so great that at morning and 
evening perceptible mists hang over the river, and to a considerable 
extent on either side, and not unfrequently heavy fogs prevail. It is 
consequently at the begining and close of the day constantly damp 
and chilly, or damp, warm and relaxing, as the temperature may hap- 
pen to be at the time. This varies probably a very little less on the 
river, for, lying further inland, it is more protected from the wind, 
though the difference is slight. The climate on the gulf coast is 
much milder, though the atmosphere is more or less humid, and fogs 
are of frequent occurrence. It is apparently less subject to storms, 
and the wind less penetrating than on the Atlantic. The mean win- 
ter temperature of the Atlantic and St. John's may be set down at 
between 55° and 60° ; the thermometer, however, often indicates 
75° and 80°, and falls to 35° and 40°, and occasionally as low as 20°. 
The mean is somewhat higher on the gulf, increasing as we go 
South. 

" In the interior of the State a very different atmosphere and cli- 
mate are found, which present, also, however, considerable local 
variation. The surface of the country ascends gradually from both 
Atlantic and Gulf coasts, and reaches its highest altitude at very 
nearly the centre of the eastern and penisula portion of the State, 
forming a flattened ridge or table land, which traverses it in a direc- 



Wall on Climate and Diseases of Florida. 11 

tion northwest and southeast, and extends to the southern extremity 
of the peninsula. The soil throughout this region, which embraces 
the largest area of the State, is generally sandy, the country flat and 
covered with immense pine forrests, interspersed here and there with 
savannahs or everglades. 

" The topography of the middle and western portions is more undu- 
lating and hilly, with greater prevalence of clay subsoil, and the vege- 
tation and forest growth suited to such soil. The climate here is 
more rugged and bleak than in any portion of the State, being the 
only section in which a marked fall of snow has ever occured. The 
highest elevation in the central section is about 300 feet, but varies 
in different localities, the general average being from 150 to 200 feet. 
The air here, as a rule, is always dry, and when changes in tempera- 
ture occur, though at times sudden, provision or accommodation by 
means of proper clothing, etc., can be made to meet such effects, 
which is difficult, if not impossible, in humid atmospheres with high 
barometric pressure." 

In a recent article on Middle Florida by Dr. Randolph, of Talla- 
hassee, published in the Floridian, a weekly newspaper, Dr. R. says 
that the climate of that section is essentially moist instead of dry, as 
Dr. H. has described it. Of these two contradictory statements I am 
disposed to accept that of Dr. Randolph, for the reason that he has 
lived and practiced physic in that section a great many years, and is 
presumably the better capacitated to judge. 

The following remarks of Dr. Horsey, extend to the northern por- 
tion of that section to which it is my desire to call attention. He 
says : " The section of country to which I especially desire to invite 
and direct attention is the central pine land regions, of which the 
towns of Gainesville, Micanopy, Ocala and Brooksville are the centres. 
Situated as these points and their surroundings are upon the highest 
and dryest section of the State, sufficiently removed from either coast 
to be beyond the effects of dampness, they appear to me t® possess 
peculiar fitness to merit all requirements of climate that are to be ob- 
tained. We have here the healthful influence of that peculiar aromatic 
element proverbial to the air of turpentine countries, which I regard 
as not altogether mythical in its effects, for at least it is inviting for 
out-door exercise and exertion, and thereby plays a very important 
role in my idea of the requisites for improvement." 

He further says : "I have thoroughly explored the country around 
Gainesville for a considerable distance, and do not hesitate to recom- 
mend this region, which embraces the counties of Alachua, Marion, 
Sumpter, Wayne, and parts of Hernando, as in my opinion the most 
eligible section of the State." 

To this I give my hearty assent so far as it goes, but it should also 
include the whole of Hernando, and the counties of Hillsborough, 
Polk, Manater, and a portion of the very large county of Monroe. 
These latter counties are peculiarly exempt from malarial fevers, much 
more so than any others within my knowledge in the State, and their 



12 Wall on Climate and Diseases of Florida. 

natural salubrity may be appreciated, when I state that these counties, 
with an aggregate population of over 10,000 souls, do not average two 
practicing physicians a piece. I do not include Key West, which, 
although in Monroe, forms a distinct community of itself. 

The following extract is taken from a report, written in 1853, from 
near New Smyrna, by Assistant Surgeon Robert Southgate, to the 
Surgeon-General : 

" Lying mostly between two seas, Florida is, by position, entitled to 
an equable climate ; and yet, on this coast, and in this latitude, equa- 
bility can hardly be considered characteristic of it. During *the winter 
and spring the atmospherical changes are often sudden and marked. 
Even in this respect, however,. Florida, contrasted with other sections 
of our country, can claim a superiority. Rarely is the change so 
great as to impress an individual, in fair health, uncomfortably; and 
the invalid has, generally, sufficient warning to guard against it. In 
relation to general health, indeed, equability can hardly be considered 
the most vital element of climate; the highest degree of physical 
vigor being attained in climates of which variableness is a striking 
quality. The human organism is constituted for such irritations ; 
and were it subjected to the monotonous impression of a uniform tem- 
perature for a length of time, its powers would, unquestionably, lan- 
guish. Even in special cases, such as chronic diseases of the lungs, 
the marked difference, during the summer, between the temperatures 
of day and night so characteristic of the climate of the coast, would 
probably be of service to the invalid. The refreshing sleep that may 
be enjoyed during the cool nights of midsummer, with the ivigorating 
sea-breezes of the day, must in his, as well as other cases, marked by 
debility and irritation, promote the general health ; while the fact 
that, during the winter, the temperature is rarely so depressed that 
exercise in the open air may not be enjoyed, will render it a salutary 
residence during that season of the year. Exercise in the open air, 
by maintaining the vigor of digestion, and the appeasing the wearing 
excitement of the heart and arteries, must economize the vital force 
and save the integrity of the tissues ; and to the consumptive invalid 
these considerations are of the very first importance." 

What Dr. Southgate says in favor of the climate of Florida in rela- 
tion to consumption, is peculiarly applicable to that of this section. 
We have no such vast bodies of sluggish fresh waters, as is found 
along the St. John's, continually exhaling moisture to be precipitated 
as fogs and mists, by the air cooling through rapid terrestial radiation. 
Nor are we troubled with storms or continuous northern blasts com- 
mon on the Atlantic. The winds never eontinue long from an} r 
direction, as may be noticed by reference to the meteorological tables 
in the first part of this article, which, however, are not to be inter- 
preted as meaning that the wind is continuously from the various 
points of the compass, as there given. While breezes more or less 
strong are common, the idea that the peninsula is traversed by them 
alternately from Atlantic to Gulf, and vice versa, from Gulf to Atlan- 



Wall on Climate and Diseases of Florida. 13 

tic, may be considered a mere poetical fancy, contrary to the known 
general laws of air currents. 

In this connection it may not be amiss to state also, that the inte- 
rior pine land region spoken of by Dr. Horsey, is not altogether ae 
level as might be inferred from his description ; while in places it is 
so, much of it is undulating, even up to the Gulf beach in some places; 
and some distance in the interior this undulating character extends so 
far as Fort Meade, 46 miles southeast of Tampa, which is 80 feet 
above sea level. I have given the mean altitude of this interior 
region as about 40 feet above the sea-level, which may be a little less 
than it actually is. My data are taken from the published statistics 
of the Surgeon-G-eneraPs office, referred to in the topographical sketch. 
Dr. Toner gives the altitude of Gainesville as 160 feet. The statistics 
give the altitude of Fort King (near Ocala) as 50 feet; Fort Mica- 
nopy (12 miles south of Gainesville) as 60 feet; Fort Brooke (at 
Tampa) 30 feet. For cantonments, rather elevated spots were select- 
ed by the officers. I have already referred to the distinet features of 
surface drainage in the two sections divided by the 28° of latitude ; 
that north being in many places subterranean, while that south is 
entirely superficial by means of creeks and ravines, so that in the 
rainy season the latter section is more or less inundated for short 
periods at a time. 

Cases of pulmonary tuberculosis, occurring in natives or old resi- 
dents, are extremely infrequent. In a professional experience 
in this section of 15 years, not more than half a dozen cases have 
come under my observation, and the whole number occurring south of 
Ocala, will probably not exceed a dozen or so for the same length of 
time. Another fact to be borne in mind is, that in no instance where 
the disease was so styled, was the diagnosis verified by a post mortem 
examination ; so that in view of an advanced knowledge in pulmonic 
pathology and diagnosis, and the lack of clinical experience in this 
disease, to say nothing of professional inaptitude and false judgment 
among the majority of ordinary practitioners of medicine, the correct- 
ness of the diagnosis may reasonably be questioned in some cases. 

In the majority of the cases the disease occurred in young men 
with no marked family predisposition ; within my knowledge, never 
in females or negroes. These facts are rather suggestive of the exci- 
ting cause having been to some extent, at least, vicious practices, or 
venereal excess, associated with other deleterious habits. ( Vidi Ac- 
tion on Reproductive Organs, p. 117.) On the other hand, I know 
several men who, as soldiers, being then young, in the western and 
Virginia campaigns, were attacked with bronchorrhrgia, and having 
been discharged in consequence, on their return to their homes, in 
this section of the State, regained their health, and have continued 
since in a robust, healthy condition. Some of these parties, as appli- 
cants for life insurance, have been examined by me within the last 
year or so, and in no instance was there any symptom or sign of pul- 
monary disease. The companies, however, at the Home office, inva- 
riably rejected them on account of the early hoemoptysis. 



14: Wall on Climate and Diseases of Florida. 

Since the war but few invalids have visited Tampa, the St. John's 
being their great thoroughfare, so that I have no personal experience 
to offer in observing the effects of climate on them. What few I 
have seen were generally expectant, if not sanguine, of great results 
from climate alone, and discarded cod liver oil and alchohol as reme- 
dies. Unfortunately, in a disease where death is the rule and cure 
the exception, it will take long and persistent observation of a large 
number of cases, whose clinical histories are to be followed year after 
year, to determine anything positively as to the benefits to be derived 
by resorting to any section or climate. American physicians have 
not hitherto exhibited a zeal in this direction anything like equal to 
that of the English. The result is that, from insufficient generaliza- 
tion, or generalizing from an insignificant number of cases, many 
places in various sections of the Union have acquired an ephemeral 
reputation as a winter resort for consumptives. 

In all cases the physician should endeavor to determine the stage 
of the local disease in the lungs, and the character of its progress, 
whether slow or rapid, and then conclude from these circumstances, 
taken in connection with the general condition, whether or not a 
change of climate is likely to prove beneficial. In selecting a climate 
the course recommended by Dr. Austin Flint may be adopted. He 
says : 

11 The feelings and choice of the patient are to have considerable 
weight. If, when in health, more vigor and enjoyment are habitually 
experienced in summer than in winter, a warm climate will probably 
be best, and, if the reverse be true, a cold climate is to be preferred. 
The condition of the patient as regards feebleness is an essential point. 
If he be so feeble as not to be able to live out of doors in cold weather, 
or if the reaction from the impression of cold be slow and imperfect, a 
warm climate is more suitable. It is rarely proper to send patients to 
a cold climate if the disease be considerably advanced, and, as a rule, 
a cold climate is better suited to male than to female patients." He 
further &&y$> : " Places which are especially the resort of patients are 
to be avoided ) the, moral effect of seeing daily examples of different 
stages of the disease is unfavorable." 

The employment of the mind in connection with out of door exer- 
cise is, in the estimation of the author just quoted, of the greatest im- 
portance. Here these requirements can be readily met, either in 
hunting or fishing; or by establishing a more or less permanent home, 
and engaging in orange growing, etc., both health and profit might be 
the reward. 

It is not my purpose to go into the treatment of consumption, but 
it may not be inappropriate to say that, discarding the use of the well 
known remedies, cod-liver oil and alcohol, and relying alone on chi- 
matic conditions, however favorable,' will, in the majority of cases, end 
in disappointment. That recovery, or at least great improvement, has 
been the result of a more or less continued residence in this section, 
indepently of medication, is vouched for by very reliable authority. 



WALLon Climate and Diseases of Florida. 15 

In confirmation of this I shall take the liberty of introducing the fol- 
lowing communication with cases from Dr. F. Branch, who has resid- 
ed and practiced medicine in South Florida since 1848 ; 

Dear Sir : In answer to your inquiry respecting the influence of 
the climate, on the Gulf coast of South Florida, upon persons afflicted 
with diseased lungs, I cheerfully furnish the following facts which 
have transpired under my own observation : 

" Case I. W. B., from Green County, Ala., came to Manater, a 
settlement below Tampa, in the fall of 1851, laboring under a severe 
cough, having a cavity in the right lung, from which was discharged 
nearly half a pint of pus daily ; so enfeebled as to be unable to walk 
fifty yards, and was greatly emaciated, having night sweats. He took 
scarcely any medicine, depending upon gentle exercise in the open air, 
and milk diet for recuperation. After about nine months residence 
in Manater, his night sweats had disappeared, the pain had left his 
lung, his expectoration had nearly subsided, and he was able to walk 
a mile with but little fatigue. Before the expiration of another year 
he deemed himself well, and decided to visit his home in Alabama. 
I advised him to go in June, and return in August. He left in June, 
and, remaining there, in October his cough returned, with all his for- 
mer symptoms ; and he did not leave for Florida until the 10th of 
December, and his case terminated fatally on the 10th of March. Had 
he remained in South Florida, he might have lived for several years. 

" Case II. A. G., a practicing attorney, from Memphis, Tenn. r 
came to Manater, Fla., in the fall of 1849. He was extremely ema- 
ciated, and had hectic symptoms, such as fever and night sweats. He 
had copious expectoration, cavity in the right lung, loss of voice, so as 
to be unable to speak above a whisper, and was unable to take any 
exercise. He refused medication, not even submitting to counter-irri- 
tants ; lived principally upon milk diet, eggs, fish and oysters ; spent 
considerable time moving along the coast, sleeping in tents, and often 
bathing in salt water, after he was sufficiently improved to bear the 
fatigue. His improvement was gradual, but constant, and in three 
years he had recovered his voice and his health, insomuch that he 
delivered an oration with a full volume of voice, on the 4th day of 
July, 1852. On the first day of June, 1853, he visited his home, 
near Memphis. While at home, he contracted a severe cold, his 
cough returned in an aggravated form, and in the following January 
he returned to Manater only a few days before his death. We deem 
it a legitimate conclusion that if he had remained upon the Gulf coast 
of South Florida he might have lived for several years. 

k£ Case III. M. C-, of Eufala, Ala., afilicted with diseased lungs, 
was landed at Tampa, Hillsboroug Co., Fla., on the 10th day of June, 
1847, being borne in a sheet to his boarding house, in consequence of 
extreme emaciation and debility, with no prospect of living but a few 
weeks. His progress in improvement was exceedingly slow ; but by 
the following winter he was enabled to walk a hundred yards before 
requiring rest. In about two years, he was so far recovered as to be 



16 Wall on Climate and Diseases of Florida, 

elected to the office of Clerk of the Circuit Court, which office he 
retained, performing all its functions, for thirteen years. 

- Case IV. Dr. T. came to Tampa 7 from Vermont, in 1849, hope- 
less of recovery, from diseased lungs. Resumed practice as physician, 
and lived twenty-two years. Many similar cases might be mentioned. 
Very respectfully yours, F. BRANCH, M. D." 

From the foregoing it will be noticed that a permanent residence 
in this section is of the greatest importance to the consumptive. And 
to thousands of such the facilities for making a living by agriculture 
and fruit growing, and of eventually acquiring independent incomes 
from the latter, are not to be surpassed in any section of these broad 
United States. 

Before the war many more invalids visited this section than since 
and now. The great' reason for this is entirely dependent on the 
somewhat less accessibility of this section, compared to the Atlantic 
and St. John's side. Moreover the facilities of travel and accommo- 
dations for pleasure-seekers have hitherto been inadequate, because, as 
yet, there has been no demand for such. These deficiencies can be 
readily supplied by putting the Florida R. R., from Fernandina to 
Cedar Keys, in the condition of a first-class road, with all the com- 
forts of improved cars, etc., and placing more steamers on the line 
between Cedar Keys and Tampa, touching at the other Gulf ports* 
Capital would then soon supply hotel accommodations at all desirable 
points. 

In bringing this paper to a close, I will assure the reader that I 
have been careful to avoid exaggeration, and have only set forth such 
facts and opinions as are justified by experience, observation and 
study. To thousands who annually visit the eastern portion of the 
peninsula, the greater part of this section is a terra incognita, because 
of its remoteness from the main lines of travel. The limited time 
allowed for its preparation, and the interruptions occasioned by profes- 
sional engagements, must be my excuse for any absence of methodical 
detail, and lack of literary polish. 

During the writing of this, tests for the presence of ozone in the 
atmosphere have been repeatedly made, with positive results; its 
presence being fully indicated at she expiration of three or four hours, 
day or night. The method of testing was that given in the second 
American edition of Brande and Taylor's Chemistry, and is thus pre- 
pared : " One part of pure iodide of potassium (free from iodate,) is 
dissolved in two hundred parts of distilled water ; ten parts of starch, 
finely powdered, are mixed with the solution, and the liquid is gently 
heated until it is thickened from the solution of the starch. White un- 
sized or sized paper is soaked in the liquid ; the paper is dried, cut into 
slips three inches long by three-quarters of an inch wide, and these are 
preserved in a stoppered bottle. When intended for use, a slip of 
ih.e prepared paper is exposed to a fail current of air in a spot shelter- 
ed as much as much as possible from rain, light, and foul effluvia, for 
a period varying from six to twenty-four hours." 



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